Author Affiliations: School of Economics and Management, Beijing Jiaotong University, Beijing, China (Drs Cai and Zhang); Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (Drs Guerriere and Coyte); and School of Insurance, Shandong University of Finance and Economics, Jinan, China (Dr Fan).
Cancer Nurs. 2021;44(3):214-222. doi: 10.1097/NCC.0000000000000863.
Home is often deemed to be the preferred place of death for most patients. Knowing the factors related to the actualization of a preferred home death may yield evidence to enhance the organization and delivery of healthcare services.
The objectives of this study were to measure the congruence between a preferred and actualized home death among cancer patients in receipt of home-based palliative care in Canada and explore predictors of actualizing a preferred home death.
A longitudinal prospective cohort design was conducted. A total of 290 caregivers were interviewed biweekly over the course of patients' palliative care trajectory between July 2010 and August 2012. Cross-tabulations and multivariate analyses were used in the analysis.
Home was the most preferred place of death, and 68% of patients who had voiced a preference for home death had their wish fulfilled. Care context variables, such as living with others and the intensity of home-based nursing visits and hours of care provided by personal support workers (PSW), contributed to actualizing a preferred home death. The intensity of emergency department visits was associated with a lower likelihood of achieving a preferred home death.
Higher intensity of home-based nursing visits and hours of PSW care contribute to the actualization of a preferred home death.
This study has implications for policy decision-makers and healthcare managers. Improving and expanding the provision of home-based PSW and nursing services in palliative home care programs may help patients to actualize a preferred home death.
对于大多数患者来说，家通常被认为是最理想的死亡地点。了解与实现患者首选的家庭死亡相关的因素，可以为改善和提供医疗保健服务提供依据。
本研究旨在衡量在加拿大接受家庭姑息治疗的癌症患者中首选家庭死亡与实际家庭死亡之间的一致性，并探讨实现首选家庭死亡的预测因素。
采用纵向前瞻性队列设计。在 2010 年 7 月至 2012 年 8 月期间，对 290 名患者的护理人员进行了为期两周的随访。采用交叉表和多变量分析进行分析。
家是最理想的死亡地点，68%表达过在家中去世意愿的患者实现了这一愿望。护理环境变量，如与他人同住、家庭护理探访的强度以及个人支持工作者（PSW）提供的护理时间，有助于实现患者首选的家庭死亡。急诊就诊的强度与实现首选家庭死亡的可能性降低相关。
家庭护理探访强度和 PSW 护理时间的增加有助于实现患者首选的家庭死亡。
本研究对政策制定者和医疗保健管理者具有重要意义。改善和扩大姑息治疗家庭护理项目中 PSW 和护理服务的提供，可能有助于患者实现首选的家庭死亡。
